<![CDATA[Newsroom Hospital for Special Surgery]]> https://news.hss.edu/ en-us Tue, 08 Sep 2026 12:37:36 +0200 Fri, 21 Aug 2026 21:56:51 +0200 <![CDATA[Newsroom Hospital for Special Surgery]]> https://content.presspage.com/clients/150_2373.png https://news.hss.edu/ 144 Opioid Alternatives Face an Uphill Battle Against Insurers and Doctors https://news.hss.edu/opioid-alternatives-face-an-uphill-battle-against-insurers-and-doctors/ https://news.hss.edu/opioid-alternatives-face-an-uphill-battle-against-insurers-and-doctors/652661Bloomberg featuring Seth A. Waldman, MD

]]>Bloomberg reports that opioids are a public-health pariah, leading to more than 80,000 overdose deaths a year. Patients worry they’ll get addicted to them. Doctors want nothing to do with them. And politicians of all stripes are calling for less dangerous options for treating pain.

“We are looking for absolutely anything that’s not an opioid,” says Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS said. 

Each year, about 80 million Americans are prescribed a medicine for acute pain, caused by the likes of broken bones, burns and the aftermath of surgeries. Some 50 million more have diabetic nerve damage or other types of chronic pain that lasts at least three months, an area Vertex is also studying. For the most part, patients have only two treatment options: anti-inflammatory drugs like ibuprofen, which aren’t very strong, or opioids, which are highly addictive. They frequently fight with insurers over coverage of safer pain medications, which Waldman calls “a cruel joke.” “There are times when we can’t get a non-opioid medication approved, but we can get approval for an opioid,” he says.

Read the full article at bloomberg.com. 

]]> Thu, 18 Jul 2024 09:22:00 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 In Surgical Care, Opioid Use Is Complex https://news.hss.edu/in-surgical-care-opioid-use-is-complex/ https://news.hss.edu/in-surgical-care-opioid-use-is-complex/623098American College of Surgeons featuring Seth A. Waldman, MD

]]>American College of Surgeons discusses the complexities of opioid use in orthopedics.

What is notable about prescription opioid use in the US today is that physicians, by and large, are doing better. The high tide of the epidemic saw excessive prescription rates—for example, from approximately 2 million opioid prescriptions to Medicare beneficiaries in 1991 to approximately 41.6 million such prescriptions in 2015.2 But those rates have now sharply decreased nationwide—in the case of Medicare beneficiaries, to approximately 19.1 million prescriptions in 2019.2 A 2024 Journal of the American College of Surgeons study showed that declines in rates of surgery-related opioid prescribing occurred in 81.6% of US counties between 2013 and 2017.3

This change has come as the pendulum of culture has swung from cavalier attitudes about opioids to deep concern. Across the US, healthcare centers have implemented programs meant to oversee, standardize, and reduce opioid prescribing. 

That said, few expect that opioid drugs will be eliminated from use. They are an effective, well-known, accessible pain management method, available in multiple fast-acting and extended-release formats, often at comparatively low costs—in other words, an option difficult to replace or forgo. Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS, said, “Our goal is to make sure that we’re using opioids when they’re necessary at the lowest possible dose for as short a period of time as possible, but also to make sure that people aren’t avoiding opioids when they’re necessary—because they are. They’re important drugs, still.” 

Read the full article at facs.org.

]]> Wed, 06 Mar 2024 16:10:58 -0500 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 HSS Opioid Stewardship Initiatives: Tackling the Opioid Epidemic from Every Angle https://news.hss.edu/hss-opioid-stewardship-initiatives-tackling-the-opioid-epidemic-from-every-angle/ https://news.hss.edu/hss-opioid-stewardship-initiatives-tackling-the-opioid-epidemic-from-every-angle/591258HSS has made significant strides in fighting the opioid epidemic over the last six years at every part of the usage life cycleOver the six years of its opioid stewardship initiative, Hospital for Special Surgery (HSS) has made dramatic progress in reducing opioid prescribing and implementing opioid-awareness tactics.

“We are implementing and perfecting initiatives that cover the full spectrum of opioid risk,” said Seth Waldman, MD, MBE, anesthesiologist and co-chair of the HSS Controlled Substances Task Force. “Our strategy encompasses the entire structure of the opioid life cycle. We are tackling this issue at every level to positively impact our community.”

HSS is a national leader in orthopedics, ranked No. 1 in the nation by U.S. News & World Report in its “Best Hospitals 2023-2024” survey.1 HSS performed more than 28,000 surgical cases in 2022. Orthopedic surgery is associated with significant perioperative pain and has been identified as a risk for long-term opioid use and misuse, making it crucial for HSS to tackle this issue.2,3

In late 2017, HSS launched an interdisciplinary Controlled Substances Task Force to prevent and mediate potential problems with opioid medications. HSS has also taken strides to tackle pain management that spans the care continuum.

“Opioid stewardship has had a tremendous impact on prescribing culture at HSS,” said Bobby Stack, MS, assistant VP of Anesthesiology, Critical Care & Pain Management at HSS and co-chair of the task force. “Large-scale initiatives have not only had direct effects on opioid safety at the hospital, including reduced prescribing, distribution of disposal packets, safety warnings, and patient education, but have also inspired departments and individuals to take initiative in pushing for smaller improvements.”

The Controlled Substances Task Force has achieved substantial results in curbing the opioid crisis in six key areas:

Further Reducing Opioid Prescribing
Since 2017, HSS has been implementing initiatives to reduce opioid prescribing across the hospital. These efforts have resulted in continued improvements to the efficacy of post-operative pain control, as seen by continuously improving patient satisfaction scores, as well as a reduction of roughly 1 million pills prescribed per year.

Expanding HSS Patient Education Content
HSS has continued to expand its patient education content with articles and videos covering a range of topics including safe opioid use and disposal, how to taper off opioids, and educating patients about what to expect regarding pain management after surgery. The task force is now branching out to more nuanced topics, including safe pain management for children and adolescents, safety tips for opioids and benzodiazepines, how to use naloxone, and more. Content is made available to patients through their MyHSS patient portal, as well as through QR codes in their discharge paperwork. This content is also on the HSS website and YouTube channel, with top-performing articles reaching nearly 10,000 views per month.

Offering CME Courses for Providers and Personalized Prescriber Training
Over the last six years, HSS has developed and implemented ongoing, personalized training to providers to help them prescribe appropriate amounts of opioid pills for their patients’ situations. Ongoing oversight by a multi-specialty committee tracks whether the training was effective based on provider compliance, and provides follow-up education as needed. HSS also offers numerous CME hours’ worth of educational content for new doctors, ongoing content for existing providers to meet New York State and federal prescribing requirements, as well as regular presentations and webinars focused on new developments and quality assurance in safe opioid prescribing. 

Providing Safe Opioid Disposal Methods to Patients and Staff
HSS was one of the first hospitals in the United States to distribute free prescription disposal products to patients at discharge. Since 2017, HSS has been sending every surgical patient home with DisposeRx®, a small packet of powder mixed with water and any leftover prescription pills to render them unusable. DisposeRx, Inc has also partnered with HSS on initiatives to hand out disposal products on site, as well as to mail every HSS employee a DisposeRx® packet as part of HSS’ annual Opioid Awareness Month initiatives. Our goal is to get as many safe disposal products into the community as we can. HSS also provides a safe drop-off location on campus for unused medications.

Distributing Naloxone and Providing Training for Overdose Emergencies
HSS is a proud participant in the New York State Opioid Overdose Prevention Program (OOPP). We provide free naloxone kits to high-risk surgical patients and make kits available to HSS staff upon request. This year, for Opioid Awareness Month in September, we are training staff in how to administer naloxone and focusing on an initiative to distribute naloxone kits to as many staff as we can. The more naloxone is available in the community, the more lives can potentially be saved.

Expanding Our Research

Starr Foundation Grant

In late 2019, HSS received a $3 million grant from the Starr Foundation to establish the C.V. Starr Endowed Chair in Pain Management. This grant has enhanced existing pain management studies and funded new studies, expediting the translation of research findings into practice, improving safe prescribing practices, and exploring alternatives to opioids.

Seth A. Waldman, MD, Co-Chairman of the HSS Controlled Substances Committee and Advisor of Opioid Prescribing Practices at HSS, is the inaugural holder of the chair. The grant funds a full-time PhD researcher dedicated to these topics, Alexandra Sideris, PhD

Pain Prevention Research Center (PPRC)

Founded in 2023, the Pain Prevention Research Center (PPRC) at HSS is unique in its focus and commitment to studying the prevention of pain and outcomes associated with pain. The PPRC’s goals include identifying innovative approaches to prevent pain; conducting high-quality research on the prevention of pain and its adverse effects; and expediting the development of therapies for those who suffer from pain.

Future Plans

Building on its well-rounded strategy for tackling the opioid epidemic, the HSS Opioid Task Force has future plans to both refine and expand its initiatives.

“We are working on evolving our methods to better identify patients at high risk for issues with controlled substances and pain management,” said Dr. Waldman. “We are developing new tools for preoperative screening to figure out which patients are at high risk for dependence or addiction, as well as which patients may need non-standardized pain management techniques or preventive strategies as part of their care. This information will help us to proactively provide more targeted and effective treatments and optimization throughout the patient’s clinical experience.”

“We are also working on developing media that will go beyond basic education about safe use, tapering, and disposal to delve into topics that we might not otherwise be discussing,” Ms. Stack said.

Moving forward, one of HSS’s major goals is to continue educating others about what we have learned about opioid management and education, so it becomes the standard of care at other hospitals and facilities. HSS also plans to keep learning from experts in the field to continue improving on a bio-psycho-social approach to pain management.

Seth Waldman, MD, MBE, is an anesthesiologist and co-chair of the HSS Controlled Substances Task Force. He is the Advisor for Opioid Prescribing Practices at HSS, the C.V. Starr Endowed Chair in Pain Management, a physician consultant to the U.S. Department of Justice and Drug Enforcement Administration, a consultant for the HSS Clinical Ethics Service, and a Pain Management Physician for the New York Giants.

Roberta (Bobby) Stack, MS, is an assistant VP of Anesthesiology, Critical Care & Pain Management at HSS and co-chair of the HSS Controlled Substances Task Force.

References

  1. https://health.usnews.com/media/best-hospitals/BH_Methodology_2023-2024
  2. Soffin EM, Wu CL. Regional and Multimodal Analgesia to Reduce Opioid Use After Total Joint Arthroplasty: A Narrative Review. HSS Journal. 2019 Feb; 15(1):57-65. doi: 10.1007/s11420-018-9652-2
  3. Soffin EM, Waldman SA, Stack RJ, Liguori GA. An evidence-based approach to the prescription opioid epidemic in orthopedic surgery. Anesth Analg. 2017 Nov;125(5):1704-1713. doi: 10.1213/ANE.0000000000002433
]]> Wed, 20 Sep 2023 10:00:00 -0400 https://content.presspage.com/uploads/2373/f873f2aa-97ed-40d0-ba06-bc0a9ce8dbdf/500_808a4643.jpeg?10000 https://content.presspage.com/uploads/2373/f873f2aa-97ed-40d0-ba06-bc0a9ce8dbdf/808a4643.jpeg?10000 Everything You Should Know About Allodynia https://news.hss.edu/everything-you-should-know-about-allodynia/ https://news.hss.edu/everything-you-should-know-about-allodynia/485890Healthline featuring Seth A. Waldman, MD

]]>Healthline discusses potential causes of allodynia, an uncommon symptom that can result from several nerve-related conditions, and includes insight Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS.

The article notes that some research has found opioid use can induce hyperalgesia, a condition involving amplified pain that can lead to allodynia.

Dr. Waldman said, “Opioid exposure causes changes in the central nervous system, which can also lead to an intensification of other sensations of pain, including but not limited to allodynia.”

Read the full article at Healthline.com.

]]> Fri, 19 Nov 2021 12:06:00 -0500 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 What to Try and What to Skip for Pain https://news.hss.edu/what-to-try-and-what-to-skip-for-pain/ https://news.hss.edu/what-to-try-and-what-to-skip-for-pain/466794Consumer Reports featuring Seth A. Waldman, MD

]]>Consumer Reports discusses strategies for pain relief according to experts including Seth A. Waldman, MD, director of Pain Management at HSS.

According to Dr. Waldman, “One of the biggest problems I see among older patients with chronic musculoskeletal pain is desperation, because there are risks associated with many common medications, even over-the-counter (OTC) ones, and there’s usually no magic drug or procedure that can fix their problem.”

He continued, “Often­times, the safest and most effective treatments are nondrug options.”

Dr. Waldman recommended mindfulness meditation as a supplemental strategy. He said, “I’ve found it can be a very powerful tool when used with other nondrug therapies to relieve pain.”

Read the full article at Consumerreports.org.

]]> Sun, 25 Jul 2021 19:19:00 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 How Pain Management Specialists Can Help You Treat Chronic Pain https://news.hss.edu/how-pain-management-specialists-can-help-you-treat-chronic-pain/ https://news.hss.edu/how-pain-management-specialists-can-help-you-treat-chronic-pain/437094TheHealthy featuring Seth A. Waldman, MD

]]>TheHealthy discusses the causes of chronic pain according to experts including Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS, and others, and how pain specialists use medications and treatments to help manage symptoms.

“The sensation of pain is initially a signal to the brain that there is actual or impending injury to the body,” said Dr. Waldman. “A complex cascade of events follows the initial signal to the brain, including withdrawing from the source of injury—think quickly removing your hand from a hot stove—but also avoiding the painful area, and spasm of muscles around the area.” This goes away as the injury heals. There’s a problem when the source of the pain is ongoing. “When the signal persists, changes begin to occur in the nervous system, including the peripheral nerves, which supply the skin, muscle, and bone, as well as in the spinal cord and brain,” he added. “This can cause the signal to spread to other areas in the nervous system, causing what is known as a ‘chronic pain state.'”

Medications may be part of your treatment, but pain management isn’t just about popping a pill for relief. “Simply providing injections or opioid pain medications is not pain management,” explained Dr. Waldman. That said, some medical treatments may be part of your program, including steroids, anticonvulsants, and antidepressants, he cited. If your underlying condition is not already being treated, “we also refer for other medical or surgical evaluation when appropriate, such as to a surgeon, neurologist, oncologist, or rheumatologist,” said Dr. Waldman.

Dr. Waldman noted opioids are very effective particularly for severe short-term pain, such as after trauma or surgery, but it’s important to minimize their use. In addition to concerns about substance use disorder, they can actually make chronic pain worse over time. “While opioids can provide great relief, because they change the way the body’s self-regulating endorphin system responds to pain, they can at times cause an increase in pain called opioid hyperalgesia.”

The commitment to reducing pain also will likely involve some everyday changes on the patient’s part. “There are numerous treatments for pain, including simple things such as heat and cold,” noted Dr. Waldman. “We also prescribe lifestyle changes, including weight loss.”

Dr. Waldman concluded, “Pain can be difficult to assess and treat, but regardless of the primary specialty of the pain specialist, the most effective therapy results from a combined approach."

Read the full article at Thehealthy.com.

]]> Wed, 17 Feb 2021 15:47:00 -0500 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 Nonopioid Multimodal Pain Protocol Effective For Common Orthopedic Sports Procedures https://news.hss.edu/nonopioid-multimodal-pain-protocol-effective-for-common-orthopedic-sports-procedures/ https://news.hss.edu/nonopioid-multimodal-pain-protocol-effective-for-common-orthopedic-sports-procedures/427384Anesthesiology News featuring Seth A. Waldman, MD

]]>Anesthesiology News reports on study outcomes indicating postsurgical pain following common sports medicine procedures can be managed effectively with a nonopioid multimodal analgesic protocol that relies more on nonsteroidal and anti-inflammatory drugs.

Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS, who wasn’t involved in the study, provided commentary on the findings stating, “Postoperative nonopioid treatment regimens have been published previously, and they are each important in that the entire body of work demonstrates that many surgeries can be performed with less exposure to opioids, and sometimes without opioids at all. Furthermore, such studies are evidence of a cultural change in perioperative medicine, which is driven by the need to improve patient safety and surgical outcomes.” Dr. Waldman added, “There is a recognition that successful recovery requires not only a satisfactory mechanical outcome, but one which minimizes the risk of addiction, overdose, diversion, opioid-induced hyperalgesia and persistent postoperative pain.”

He concluded, “It is important for clinicians and policymakers to keep in mind that there is still currently a role for the use of opioids, and that the elimination of opioids is not a goal in itself. There are very significant individual and public health risks associated with the use of opioids, but they remain very effective and should be used when necessary, at as low a dose as possible, and for as brief a time as possible.”

Read the full article at Anesthesiologynews.com.

]]> Wed, 25 Nov 2020 19:22:00 -0500 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 The Secret to Relieving Your Pain: The Right Words https://news.hss.edu/dr-waldman-the-secret-to-relieving-your-pain-the-right-words/ https://news.hss.edu/dr-waldman-the-secret-to-relieving-your-pain-the-right-words/368722Bottom Line Health featuring Seth A. Waldman, MD

]]>Bottom Line Health spoke with Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS, about how to describe pain accurately to a physician, in order to receive the appropriate treatment.

Dr. Waldman explained seven key elements for describing pain, which include intensity on a scale of 0-10; words and stories to describe what the pain feels like; the location and duration of the pain; what makes the pain better or worse; the psychological impact (if any); and medications being taken for relief.

Dr. Waldman also suggested keeping a pain diary for at least a week prior to a scheduled physician’s appointment, to clearly communicate the details of the pain to a physician.

Read the article at Bottomlineinc.com.

]]> Tue, 26 Nov 2019 17:09:00 -0500 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 HSS Receives $3 Million Grant from The Starr Foundation https://news.hss.edu/hss-receives-3-million-grant-from-the-starr-foundation/ https://news.hss.edu/hss-receives-3-million-grant-from-the-starr-foundation/362217Gift Will Establish the C.V. Starr Endowed Chair in Pain ManagementHSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 15th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2024-2025), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

]]>The Starr Foundation announced the gift of a $3 million grant to Hospital for Special Surgery (HSS) to establish the C.V. Starr Endowed Chair in Pain Management. This commitment will provide support to enhance pain management research, program development and physician education at HSS.

As the No. 1 hospital for orthopedics in the United States for 10 straight years, HSS has a responsibility and opportunity to set the highest standard for opioid management, as orthopedic surgeries are linked to substantial postoperative pain and higher numbers of opioids prescribed.

“As a leader in pain management, HSS is sharing knowledge and assisting other organizations in the implementation of safe, responsible and effective practices for managing postsurgical and chronic pain, and this grant will allow us to continue that work,” said Louis A. Shapiro, CEO and president of HSS. “We are very grateful for The Starr Foundation’s generosity and dedication to keeping all patients safe.”

HSS established a Controlled Substances Task Force in 2016 to build a better model for safe opioid prescribing while also effectively managing pain in a personalized and multifaceted way. Since its inception, the task force has taken a comprehensive look at current practices across the hospital and implemented new systems, guidelines and educational initiatives to improve patient safety and advance how perioperative and chronic pain are treated.

“HSS is a living laboratory for musculoskeletal pain management, in which we workshop new ideas, build scientific cases for support and work with medical and industry partners to bring our findings to life,” said Seth A. Waldman, MD, director of the Pain Management Division in the Department of Anesthesiology, Critical Care & Pain Management at HSS, who will be the inaugural holder of the chair. “We have developed science-based protocols, contributing to a safer prescribing environment and a more comprehensive care model across the hospital.”

This grant will both enhance existing pain management studies and allow for new studies to be initiated, accelerating the research timeline to translate findings into practice. It will also fund a full-time PhD researcher who will be responsible for coordinating those studies across HSS, to improve safe prescribing practices and explore alternatives to opioids.

“We are strategically focused on developing new multimodal programs and a clearer understanding of the bioethical issues related to pain treatment,” added Dr. Waldman, who explained that research can lead to the most rapid and meaningful advancements in patient care. “This grant will help us achieve our goals.”

HSS is also collaborating with other leading medical organizations to advance opioid initiatives across the healthcare community. One part of this effort was an international multidisciplinary forum titled “Toward Opioid-Free Arthroplasty: A Leadership Forum,” featuring representatives from orthopedics, anesthesiology, psychiatry, bioethics, health information technology and law. Coming out of that forum, held in 2018, was a consensus statement to shift toward opioid-free arthroplasty for hip and knee replacements.

While the Starr Endowed Chair will live within the Pain Management Division, the work will influence research studies across HSS.

]]> Thu, 17 Oct 2019 08:00:00 -0400 https://content.presspage.com/uploads/2373/500_dr.waldman-opioidconference-432229.jpg?10000 https://content.presspage.com/uploads/2373/dr.waldman-opioidconference-432229.jpg?10000 Opioid Management: How HSS Rises to the Challenge https://news.hss.edu/dr-albert-dr-waldman-opioid-management-how-hss-rises-to-the-challenge/ https://news.hss.edu/dr-albert-dr-waldman-opioid-management-how-hss-rises-to-the-challenge/357453OrthoSpineNews.com featuring Todd J. Albert, MD, and Seth A. Waldman, MD

]]>OrthoSpineNews.com spoke to Todd J. Albert, MD, Surgeon-in-Chief Emeritus at HSS, and Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS, to discuss how HSS has decided to tackle the issue of opioid prescribing.

Dr. Albert explained, “There are gaps and inconsistencies in physicians’ knowledge regarding opioid prescribing. We at HSS realized this early on and in 2016 we created an education program for our healthcare providers and demanded 100 percent participation.” We then launched into developing service-specific guidelines and simultaneous studies on what exactly was being prescribed, and developed guidelines to help patients dispose of unused opioids appropriately, he added.

Dr. Waldman cited, “Opioid prescribing can have dangerous consequences, and at our institution we made a conscious decision to do what we could to minimize the individual variability between clinicians. It is no longer acceptable to write a prescription without details on why this patient needs a certain medication and dose, as well as the plan for how she or he will be safely tapered off the medication. We require all our prescribers to establish an opioid contract with their patients...and our electronic health record (EHR) notifies the clinician when it is time to renew it. In addition, when necessary, we provide individual coaching for prescribers who need help discussing opioid treatment with their patients.”

Dr. Waldman advised, “Those who wish to implement similar programs at their own institution should know that the first and most important thing you have to change is the culture of the hospital itself. At HSS, opioid stewardship is everyone’s responsibility. Surgeons want the best outcomes for their patients and wouldn’t bring someone with a complex pain problem to the OR without the evaluation and treatment of a pain specialist, any more than they would ignore the preoperative recommendations of a cardiologist. If you want to effectuate this kind of change at your facility, get your administrators and surgeons on board.”

Read the full article at OrthoSpineNews.com. A subscription is warranted for access.

]]> Tue, 03 Sep 2019 14:52:00 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 How Hospital for Special Surgery prescribed 500K fewer opioid pills in 18 months https://news.hss.edu/dr-waldman-how-hss-prescribed-500k-fewer-opioid-pills-in-18-months/ https://news.hss.edu/dr-waldman-how-hss-prescribed-500k-fewer-opioid-pills-in-18-months/349505Becker's Hospital Review featuring Seth A. Waldman, MD

]]>Becker’s Hospital Review reports HSS implemented a Controlled Substances Task Force to limit the risk of opioid misuse among patients who undergo orthopedic surgeries each year.

Becker’s Hospital Review spoke to Seth A. Waldman, MD, anesthesiologist and director of the Pain Management Center at HSS, about how the task force has helped to lower opioid prescribing rates, increase provider education and identify high-risk patients, among other benefits.

Dr. Waldman explained the HSS preoperative pain assessment and treatment program is unique to the Hospital. "When I speak with anesthesiologists and pain specialists from other hospitals, one of the most significant issues they face regarding opioid prescribing is how best to care for patients who are at increased risk for using opioids perioperatively (such as those with an addiction history, sleep apnea, who have had problems with post-op pain control in the past, or are already on high-dose opioids), or who may already be on a regimen that is not medically appropriate for other reasons. The usual response is that they just do the best they can postoperatively, which we feel is not in the patient's best interest,” said Dr. Waldman.

While implementation of the program posed a number of challenges, including staff and patient education, monitoring prescribing behavior and documentation, Dr. Waldman noted, “There is no way that any of these programs could have been instituted without the support of our hospital administration, particularly our president, surgeon-in-chief and physician-in-chief. This is more about a culture change than about any one policy.”

Dr. Waldman concluded, “We have worked hard to change the culture at HSS around responsible opioid prescribing. As a surgical hospital, it is unlikely that we will ever be completely opioid-free — these are extremely effective medications, which, for now, are a necessary component of how we alleviate suffering and perform modern surgery. Opioids can also be extremely dangerous not just for the individual, but for the public health, and it is our responsibility to use them as effectively and safely as possible.”

Read the full article at Beckershospitalreview.com.

]]> Tue, 06 Aug 2019 09:24:00 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 HSS Controlled Substances Task Force Accomplishments: An Update https://news.hss.edu/hss-controlled-substances-task-force-accomplishments-an-update/ https://news.hss.edu/hss-controlled-substances-task-force-accomplishments-an-update/344537HSS created a Task Force to fight the opioid epidemic that has made substantial progress over the last two years - here’s how they did itHSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 15th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2024-2025), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2023-2024). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a fourth consecutive year (2023). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.

]]>Into their second year of implementing key initiatives, the Hospital for Special Surgery (HSS) Controlled Substances Task Force has achieved substantial results in the fight against the opioid epidemic in three key areas: considerably reducing opioid prescribing, increasing clinician and patient education, and identifying and working with high-risk patients.1

HSS is a national leader in the field of orthopedics, performing approximately 32,000 surgical cases in 2018. Orthopedic surgery is associated with significant perioperative pain, and has been identified as a risk for long-term opioid use and misuse.2,3

To prevent and mediate potential problems with opioid medications, HSS has implemented a pain management program that spans the care continuum, and in late 2017, launched the interdisciplinary Controlled Substances Task Force.

“The Controlled Substances Task Force was created in order to centralize the hospital’s opioid policy, so we’re all prescribing opioids appropriately, in an evidence-based fashion, and in a consistent way,” said Seth Waldman, MD, anesthesiologist and director of Pain Management at HSS. “Before the Task Force was created, the existing processes were somewhat haphazard. Now, we’ve standardized what prescriptions are given according to procedure; doctors can still use their clinical judgment, but they can refer to the base prescriptions. We’ve also made documentation of prescriptions consistent (i.e., what was prescribed and why?) as well as standardizing checking toxicology screens, narcotic takeback, etc. We’ve made it consistent for everyone prescribing at every circumstance.”

“The task force also aimed to make the opioid prescribing process and analysis as seamless as possible. Electronic health records have helped with that; we are able to monitor our progress, see the flow of prescriptions and whether medications are being used appropriately or not, and see the amount of opioids doctors prescribe to identify doctors who need help with prescribing and documenting,” Dr. Waldman said.

“One of the main goals of the Task Force was to change the culture of prescribing in the hospital,” said Bobby Stack, MS, an assistant VP of Anesthesiology, Critical Care & Pain Management at HSS and co-chair of the HSS Controlled Substances Task Force. “We were able to accomplish that by educating clinicians and highlighting the risks of overprescribing opioid medications.”

HSS Controlled Substances Task Force Accomplishments To Date

  • Opioids issued were reduced by 500,000 over approximately 18 months, and there have been continued reductions in the number of pills prescribed at discharge due to implemented prescribing guidelines
  • Preliminary internal results suggest that preoperative complex patient screening may reduce length of stay by up to 26%
  • Every week, up to 30 high-risk preoperative patients are identified and put on a plan to prevent opioid use complications after surgery
  • Physicians who prescribed a higher than average amount of opioid medications received one-on-one education, reducing their average number of opioid prescriptions written per month by approximately 27% compared to their pre-intervention average
  • At an HSS leadership forum in June 2018, a multidisciplinary panel of experts produced a consensus statement about appropriate pain management for total hip replacement and total knee replacement: “Consensus Statement: Toward Opioid-Free Arthroplasty,” published in a special edition of HSS Journal
  • Patient/provider opioid agreements were designed and successfully implemented in all service areas across the hospital, with nearly 100% patient compliance with signing

“The reason the task force has been so effective is that we have a variety of different partnerships; the clinician and administrative partnership has been vitally important,” said Dr. Waldman. “I can’t accomplish my part without Bobby on the administrative side. This effort has also required the support of CEO Lou Shapiro and hospital administration, not just financially but also culturally. And it’s been the support of the Surgeon in Chief and the Physician in Chief that has allowed us to implement preoperative screening services.”

“Since implementing these changes, the doctors have seen not only a huge difference in the care of patients, but it’s also simplified their care of patients in pain by providing better guidelines about how, when, and why to prescribe opioid medications; it’s been a support to them both medically and legally,” he added.

The Task Force’s results were achieved through actions taken in three key areas:

1. Educating Patients and Clinicians

2. Inspiring a Culture of Conservative Prescribing

  • Guidelines were developed to standardize prescribing and documentation for patients receiving opioids at discharge
  • Prescribing patterns for all clinicians is under ongoing analysis, which can help surgeons set patient expectations for opioid therapy perioperatively
  • One-on-one counseling and training was scheduled for clinicians who deviated from the average opioid prescribing patterns according to specialty and diagnosis
  • An opioid disposal mechanism was provided via a DEA approved disposal receptacle located on the HSS main campus

3. Identifying and Managing At-Risk Patients

  • Complex patients who are referred to the screening program receive a comprehensive evaluation with a pain management physician, and most also receive a toxicology screen
  • For patients identified as high risk, the HSS Preoperative Controlled Substances Clinical Team:
    • Engages the patient’s outside prescriber
    • Implements taper schedules
    • Makes referrals to psychiatric/psychological resources or to detox, substance use disorder facilities, 12-step groups, or private psychiatric addiction clearance facilities when appropriate
    • Delays elective surgery if necessary until the patient is treated and can safely proceed
    • Carefully monitors inpatients and implements strategies to minimize opioid use and wean medications after recovery

“The philosophy behind the Task Force is not to avoid opioid use, but to use these medications in a medically and ethically responsible way,” said Dr. Waldman. “The term that’s being used to describe this is ‘opioid stewardship.’ These medications can do a lot of good, but also terrible harm; our goal is to use them in a way that they’re not causing any more harm than they have to.”

The Controlled Substances Task Force is expanding this work with further initiatives for 2019.

“Some of the work the Task Force is looking to do moving forward includes: providing mechanisms to help patients dispose of prescriptions after surgery, becoming a registered NY state opioid overdose prevention center, continuing to educate patient and surgeon populations, providing more holistic support and alternative therapies to opioids, and sending all patients home with an opioid tapering schedule,” Ms. Stack said.

Dr. Waldman added, “This includes making more progress in use of multimodal analgesia with anesthesiologists, nurses, and physician’s assistants, and in increasing complementary treatments such as aromatherapy, virtual reality, and massage therapy.”

“I think the most important next step is to take what we’ve learned in preoperative evaluation and managing opioid prescriptions and educate others so this becomes the standard of care elsewhere. Everyone taking opioids should be evaluated before surgery and tapered after surgery, and we believe it’s important that these principles of service line guidelines are applied outside of HSS,” Dr. Waldman concluded.

Dr. Seth Waldman is an anesthesiologist and director of Pain Management at HSS. He is a physician consultant to the U.S. Department of Justice and Drug Enforcement Administration, and a master’s candidate in bioethics at Columbia University.

Roberta (Bobby) Stack, MS, is an assistant VP of Anesthesiology, Critical Care & Pain Management at HSS and co-chair of the HSS Controlled Substances Task Force.

References

1. Waldman SA, Stack RJ, Goldstein L. Clinician-healthcare administrator partnerships: effective treatment for opioid epidemic. Healthcare Business Tech. http://www.healthcarebusinesstech.com/clinician-healthcare-administrator-partnerships-effective-treatment-for-opioid-epidemic/. Accessed April 19, 2019.

2. Soffin EM, Wu CL. Regional and Multimodal Analgesia to Reduce Opioid Use After Total Joint Arthroplasty: A Narrative Review. HSS Journal. 2019 Feb; 15(1):57-65. doi: 10.1007/s11420-018-9652-2

3. Soffin EM, Waldman SA, Stack RJ, Liguori GA. An evidence-based approach to the prescription opioid epidemic in orthopedic surgery. Anesth Analg. 2017 Nov;125(5):1704-1713. doi: 10.1213/ANE.0000000000002433

]]> Thu, 11 Jul 2019 08:00:00 -0400 https://content.presspage.com/uploads/2373/500_bigstock-holding-a-pill-blue-latex-glov-302989255-901829.jpg?10000 https://content.presspage.com/uploads/2373/bigstock-holding-a-pill-blue-latex-glov-302989255-901829.jpg?10000 Hospital for Special Surgery sees results from opioid task force https://news.hss.edu/dr-waldman-hss-sees-results-from-opioid-task-force/ https://news.hss.edu/dr-waldman-hss-sees-results-from-opioid-task-force/343640Crain's New York Business featuring Seth A. Waldman, MD

]]>Crain’s New York Business reports on the outcomes to date as a result of the HSS Opioid Task Force, aimed to combat the opioid crisis.

Crain’s New York Business spoke to Seth A. Waldman, MD, anesthesiologist and director of the Pain Management Center at HSS, about the purpose of the task force who explained, “The hospital's primary areas of focus have been educating clinicians and patients about opioids, establishing a culture of conservative prescribing and guidelines, and identifying and managing high-risk patients.” Since its implementation two years ago, the task force’s work has led to 500,000 fewer opioids prescribed. Preliminary internal results suggest preoperative complex patient screening may reduce length of hospital stay by up to 26 percent. Additionally, the hospital identifies as many as 30 high-risk preoperative patients each week and places them on a plan to prevent opioid-use complications after surgery. Clinicians who prescribe a higher than average amount of opioids, receive one-on-one education, which has on average reduced their prescriptions written each month by about 27 percent.

Furthermore, new areas of focus for the task force this year include making more progress in multimodal analgesia, pain treatment from multiple drug classes, as well as increasing complementary treatments such as virtual reality, aromatherapy and massage therapy. “The goal is to take good care of people,” said Dr. Waldman. "This does improve outcomes."

Read the full article at CrainsNewYork.com.

Additional coverage: ThePharmaLetter.com, Beckershospitalreview.com

]]> Tue, 02 Jul 2019 12:40:35 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 Preoperative protocol at HSS aims to identify patients at risk for difficult pain management https://news.hss.edu/preoperative-protocol-at-hss-aims-to-identify-patients-at-risk-for-difficult-pain-management/ https://news.hss.edu/preoperative-protocol-at-hss-aims-to-identify-patients-at-risk-for-difficult-pain-management/342207Orthopedics Today featuring Seth A. Waldman, MD

]]>Orthopedics Today reports physicians nationwide have encountered patients scheduled for orthopedic surgery who are already taking high-dose opioid pain medication. While surgeons may refer these patients to a pain management specialist, not all do, and of the patients who are referred, not all follow through with an appointment.

Orthopedics Today spoke to Seth A. Waldman, MD, director of the Pain Management Center at HSS, to discuss the perioperative program at HSS designed to identify patients at high risk for difficult pain control after surgery. This includes patients prescribed opioids above a certain dosage, on strong or long-acting opioids, with infusion pumps of opioids, with a substance abuse history or with a history of bad pain control following surgery. “The goal was to get those patients all seen by a pain management specialist beforehand so that we could speak to their provider, check their medications, know what they are on, make adjustments in medicines if possible, check toxicology screening and so on,” explained Dr. Waldman.

According to Dr. Waldman, the HSS preoperative program became more formalized around 2016 as the public became more aware of the opioid crisis. Additionally, HSS continued to adopt other protocols to reduce opioid use after surgery, starting with staff education and training. Dr. Waldman cited, “Every prescriber, every surgeon, every internist, every [physician assistant] PA, every nurse practitioner is required to take a course so that everyone has basic information with regard to the history of the opioid crisis, why opioid pain medication sometimes can cause increased pain, information about diversion, information about safe prescribing and that material became part of our enduring content.”

Read the full article at Healio.com.

Additional coverage: Beckersspine.com. 

]]> Fri, 21 Jun 2019 08:44:00 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 Clinician-healthcare administrator partnerships: Effective treatment for opioid epidemic https://news.hss.edu/clinician-healthcare-administrator-partnerships-effective-treatment-for-opioid-epidemic/ https://news.hss.edu/clinician-healthcare-administrator-partnerships-effective-treatment-for-opioid-epidemic/331901Healthcare Business Tech featuring Seth A. Waldman, MD, Roberta Stack, MS, and Lisa Goldstein

 

]]>Seth A. Waldman, MD, anesthesiologist at HSS, Roberta Stack, MS, AVP of Anesthesiology, Critical Care & Pain Management at HSS, and Lisa Goldstein, COO at HSS, detail how the hospital successfully implemented a pain management program incorporating clinicians across the care continuum, and how it overcame challenges to ensure this goal became a cornerstone of the hospital’s culture. At HSS, the goals are to prescribe opioids responsibly and promote conservative use. HSS optimizes each patient’s surgical experience and tailors treatment plans to individual complex pain needs. It also provides education and supporting resources to prescribers, patients and the community via multiple channels.

HSS appointed a medical advisor for opioid prescribing practices and creating an enterprise-wide, interdisciplinary Controlled Substances Task Force. The Task Force was charged with implementing and monitoring the progress of institutional controlled substances initiatives, which spanned broad categories including: education, safe perioperative prescribing practices and close management of the most at-risk complex patients. Additionally, The Controlled Substances Task Force led the development and provision of educational resources for prescribers, patients and the community.

In partnership with HSS surgeons, the Task Force developed novel service-specific guidelines to standardize opioid prescribing practices, patient monitoring and documentation via electronic health records, which can be accessed across all points of care.

This article previously appeared on HealthcareBusinessTech.com. 

]]> Tue, 26 Mar 2019 17:14:00 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 Toward Opioid-Free Surgery https://news.hss.edu/toward-opioid-free-surgery/ https://news.hss.edu/toward-opioid-free-surgery/321672Medscape featured Charles N. Cornell, MD, chair of the Department of Orthopedic Surgery at HSS Orthopedics at Stamford Health; and Seth A. Waldman, MD, anesthesiologist and director of Pain Management at HSS; who addressed their collaborative educational program on opioid prescribing for hospital employees.  

"What came out of it was a realization that we needed to change, and we've dramatically improved our opioid prescribing practices at the hospital. The basis for that has been multimodal analgesia, changes to our approach to physical therapy so that the physical therapy doesn't contribute to postoperative pain, and addressing patient expectations and reassuring patients that we can manage their pain without opioid medications, making recovery from surgery much safer, with fewer complications," said Dr. Cornell.

"The goal is to take good care of people, allowing them to have a safe surgery and the quickest possible rehabilitation so they can get back to where they started, which is without pain and with good function," Dr. Waldman noted.

Read the full article at Medscape.com [subscription required].

]]> Wed, 15 Aug 2018 07:00:00 -0400 https://content.presspage.com/uploads/2373/500_hss-flat-lightblue-logo-01-201130.png?10000 https://content.presspage.com/uploads/2373/hss-flat-lightblue-logo-01-201130.png?10000 What to Know Before You Try CBD Oil for Pain Relief https://news.hss.edu/what-to-know-before-you-try-cbd-oil-for-pain-relief/ https://news.hss.edu/what-to-know-before-you-try-cbd-oil-for-pain-relief/322108Prevention featured HSS anesthesiologist and director of Pain Management Seth A. Waldman, MD, in an article about cannabidiol (CBD) as an alternative treatment for pain relief.  

According to the article, the U.S. Food and Drug Administration approved CBD to treat two severe forms of epilepsy.

"Cannabidiol is generally well-tolerated, which gives it a distinct advantage over other medications currently available for pain, including (and especially) opioids, non-steroidal anti-inflammatory drugs, steroids, anticonvulsant, and antidepressant medications," Dr. Waldman explained.

He added that CBD oil is worth trying for neurological pain, but cautioned to try only one new treatment at a time.

"Start low and go slow. That is, begin with the lowest dose, used once daily, and if tolerated and necessary, the dose could be increased slowly and deliberately. It is more difficult to gauge the effects of a new treatment if it is used irregularly," Dr. Waldman noted.

Read the full article at prevention.com.

Additional Coverage:

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